The deepest cut: Self-mutilation

She always wears long-sleeve shirts. He refuses to wear shorts, even in hot weather. He has withdrawn from family, friends and activities. All are signs your child could be a cutter.

Amy Leap

She always wears long-sleeve shirts. He refuses to wear shorts, even in hot weather. He has withdrawn from family, friends and activities.

All are signs your child could be a cutter.

Like other risky behaviors, cutting is usually a sign of deeper emotional distress, said Dr. Eleanor Antolin, chair of the Department of Behavioral Health at Pocono Medical Center, East Stroudsburg.

Numbers of those who self-injure, particularly within the general adolescent population, are not known. Estimates range from 3 to 4 percent of the U.S. population.

"Cutting is a form a self-mutilation, where the cutter uses a sharp knife or object to make a straight slice either on the arms, legs or torso. Sometimes additional behavior like burning, scratching, or biting is included in self-mutilation," Antolin said.

Teens start cutting for many reasons, but usually it is because they are experiencing painful emotions, and cutting becomes an outlet.

"You have to realize that cutting is a behavioral issue that is usually a sign of a deeper issue going on," Antolin said.

"A traumatic experience, living through abuse or violence and borderline personality disorder, causing emotional instability, can be the cause of self-mutilation," she said.

Sometimes people feel such an intense release when they cut themselves, the relief and sense of control become addicting.

"It is a myth that this behavior is simply a ploy to get attention. There is a pain-killer effect that teens get from self-harm," said Dr. David Rosen, director of teenage and young adult health at the University of Michigan of Ann Arbor, Mich.

Small linear cuts, parallel like railroad ties, often carved into the forearm, upper arm and legs, are common, Rosen said.

Sometimes if they suffer from poor body image, they will carve words like "ugly" or "fat" on their arms, he said.

Don't be pacified by excuses, such as "The cat scratched me," Antolin said.

"The important thing to remember is that over time, the cutting will escalate, occurring more often," she said.

It is not going to go away, and you need to sit down and open a dialogue with your teen. As a parent, you must address the issue, Antolin said, and added, "Be direct with your child but let them know that you are going to support them and do everything possible to help them."

When a parent discovers a child who is deliberately cutting, the parent often takes the blame, Antolin said.

"Parents ask what they did wrong to make their child want to hurt him or herself. But it isn't a time to place blame; it is time to get help for your child," she said.

This isn't an issue that parents can handle on their own, and they need to recognize that. Start with the child's guidance counselor, family doctor or a recommended teen counselor who has experience in this area, she said.

"Self-harm is not a problem that teens will simply outgrow, but as they get better at self-monitoring, it will get easier for them to give up the destructive behavior," Antolin said.